Authors: D’Onofrio, Grazia | Sancarlo, Daniele | Ricciardi, Francesco | Panza, Francesco | Seripa, Davide | Cavallo, Filippo | Giuliani, Francesco | Greco, Antonio
Article Type: Research Article
Abstract: Background: Significant innovations have been introduced in recent years in the application of information and communication technologies (ICTs) to support healthcare for patients with dementia. Objective: In the present systematic review, our goal is to keep track of ICT concepts and approaches to support the range of activities of daily living for people with dementia and to provide a snapshot of the effect that technology is having on patients’ self-reliance. Methods: We reviewed the literature and identified systematic reviews of cohort studies and other authoritative reports. Our selection criteria included: (1) activities of daily living, (2) ICT, and (3) dementia. …Results: We identified 56 studies published between 2000 and 2015, of which 26 met inclusion criteria. The present systematic review revealed many ICT systems that could purportedly support the range of activities of daily living for patients with dementia. The results showed five research bodies: 1) technologies used by patients with dementia, 2) technologies used by caregivers, 3) monitoring systems, 4) ambient assistive living with ICTs, and 5) tracking and wayfinding. Conclusions: There is a potential for ICTs to support dementia care at home and to improve quality of life for caregivers, reducing healthcare costs and premature institutional care for these patients. Show more
Keywords: Keywords: Basic activities of daily living, dementia, information and communication technologies, instrumental activities of daily living
DOI: 10.3233/JAD-161145
Citation: Journal of Alzheimer's Disease, vol. 57, no. 3, pp. 927-935, 2017
Authors: Lauriola, Michele | D’Onofrio, Grazia | Ciccone, Filomena | Germano, Carmela | Cascavilla, Leandro | Paris, Francesco | Greco, Antonio
Article Type: Research Article
Abstract: Background: Alzheimer’s disease (AD) may be a vascular disorder with neurodegenerative consequences opening possibility of preventing AD by targeting vascular risk factors including homocysteine. Objective: The study aims were to assess homocysteine distribution in different forms and severity of cognitive impairment (CogI) [mild cognitive impairment (MCI), probable AD (Prob-AD), possible AD (Poss-AD), and vascular dementia (VaD)] and in NoCogI, and to estimate possible association between hyperhomocysteinemia levels with functional deficit severity and psychobehavioral complications. Methods: In total, 929 (M = 366, F = 563; mean age of 72.55±6.24 years) patients were evaluated with cognitive, neuropsychiatric, affective, and functional assessment scales. Homocysteine serum was set …on two levels: between 0 and 10μ mol/L and > 10μ mol/L. For each patient, blood concentration of folate, vitamin B12, hemoglobin, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), cholesterol, triglycerides, and glycemia were measured. Results: CogI patients demonstrated significantly a higher frequency of homocysteine > 10 (p = 0.003), than NoCogI patients. Patients with moderate and severe dementia had a higher frequency of homocysteine > 10 (p < 0.0001), than MCI and mild dementia. Poss-AD and VaD had a higher frequency of homocysteine > 10 (p = 0.003), than Prob-AD patients. Homocysteine > 10 frequency is directly proportional to increased neuropsychiatric symptom severity (p < 0.0001), and functional impairment severity respectively for ADL (p < 0.0001) and IADL (p < 0.0001). Conclusion: Higher homocysteine level seems to be significantly related to cognitive impairment frequency and severity, possible AD and VaD, neuropsychiatric symptom severity, and functional impairment severity. Show more
Keywords: Activities of daily living, Alzheimer’s disease, homocysteine, mild cognitive impairment, neuropsychiatric symptoms, vascular dementia
DOI: 10.3233/JAD-210166
Citation: Journal of Alzheimer's Disease, vol. 82, no. 1, pp. 235-248, 2021
Authors: D’Onofrio, Grazia | Panza, Francesco | Sancarlo, Daniele | Addante, Filomena | Solfrizzi, Vincenzo | Cantarini, Chiara | Mangiacotti, Antonio | Lauriola, Michele | Cascavilla, Leandro | Paris, Francesco | Lozupone, Madia | Daniele, Antonio | Greco, Antonio | Seripa, Davide
Article Type: Research Article
Abstract: Alzheimer’s disease (AD) and vascular dementia (VaD) lead to progressive decline in executive function. We estimated the prevalence of executive dysfunction in AD and VaD patients, investigating cognitive, functional, and clinical correlates and also using a multidimensional approach based on a standardized comprehensive geriatric assessment (CGA). We included 215 patients (115 AD patients and 100 VaD patients) consecutively evaluated with a complete cognitive and affective assessment, a CGA, and the Frontal Assessment Battery (FAB) with six subtests investigating conceptualization, mental flexibility, motor programming, sensitivity to interference, inhibitory control, and environmental autonomy. The prevalence of dysexecutive syndrome screened with a FAB …score <12 points was high in both AD (97 patients) and VaD (77 patients) (84.3% versus 77.0%, p = 0.171). AD patients were significantly younger, with higher grade of cognitive impairment and less severe comorbidity and polypharmacy than VaD patients. AD patients showed a significantly higher impairment in FAB total score and five FAB subtests (conceptualization, motor programming, sensitivity to interference, inhibitory control, and environmental autonomy) than VaD patients. These findings were largely confirmed in a sub-analysis conducted subdividing the sample in mild and moderate-to-severe demented patients and suggesting that in moderate-to-severe AD there was higher impairment in FAB total score and four FAB subtests (conceptualization, sensitivity to interference, inhibitory control, and environmental autonomy). Executive dysfunction could be greater in AD patients with moderate-to-severe dementia compared to VaD patients, although our groups were also not matched for age, comorbidity or polypharmacy, which could also exert an effect. Show more
Keywords: Alzheimer’s disease, comprehensive geriatric assessment, dementia, executive function, vascular dementia
DOI: 10.3233/JAD-170365
Citation: Journal of Alzheimer's Disease, vol. 62, no. 2, pp. 699-711, 2018
Authors: D’Onofrio, Grazia | Panza, Francesco | Sancarlo, Daniele | Paris, Francesco F. | Cascavilla, Leandro | Mangiacotti, Antonio | Lauriola, Michele | Paroni, Giulia H. | Seripa, Davide | Greco, Antonio
Article Type: Research Article
Abstract: In Alzheimer’s disease (AD) patients with delusions, clinical outcomes and mortality result from a combination of psychological, biological, functional, and environmental factors. We determined the effect of delusions on mortality risk, clinical outcomes linked to comprehensive geriatric assessment (CGA), cognitive, depressive, and neuropsychiatric symptoms (NPS) in 380 consecutive AD patients with Mini-Mental State Examination, Clinical Dementia Rating scale, 15-item Geriatric Depression Scale, and Neuropsychiatric Inventory (NPI), assessing one-year mortality risk using the Multidimensional Prognostic Index (MPI). We included 121 AD patients with delusions (AD-D) and 259 AD patients without delusions (AD-noD). AD-D patients were significantly older, with higher age at …onset and cognitive impairment, a more severe stage of dementia, and more depressive symptoms than AD-noD patients. Disease duration was slightly higher in AD-D patients than in those without delusions, although this difference was not statistically significant. At CGA, AD-D patients showed a higher grade of disability in basic and instrumental activities of daily living, and an increased risk of malnutrition and bedsores. The two groups of patients significantly differed in MPI score (AD-D: 0.65 versus AD-noD: 0.51, p < 0.0001) and MPI grade. AD-D patients showed also a significant higher score in NPI of the following NPS than AD-noD patients: hallucinations, agitation/aggression, depression mood, apathy, irritability/lability, aberrant motor activity, sleep disturbances, and eating disorders. Therefore, AD-D patients showed higher dementia severity, and higher impairment in cognitive and depressive symptoms, and several neuropsychiatric domains than AD-noD patients, and this appeared to be associated with higher multidimensional impairment and increased risk of mortality. Show more
Keywords: Alzheimer’s disease, comprehensive geriatric assessment, delusions, depressive symptoms, functional status, mortality, Multidimensional Prognostic Index, neuropsychiatric symptoms
DOI: 10.3233/JAD-150944
Citation: Journal of Alzheimer's Disease, vol. 51, no. 2, pp. 427-437, 2016
Metabolic Syndrome and Cognitive Impairment: Current Epidemiology and Possible Underlying Mechanisms
Authors: Panza, Francesco | Frisardi, Vincenza | Capurso, Cristiano | Imbimbo, Bruno P. | Vendemiale, Gianluigi | Santamato, Andrea | D'Onofrio, Grazia | Seripa, Davide | Sancarlo, Daniele | Pilotto, Alberto | Solfrizzi, Vincenzo
Article Type: Review Article
Abstract: A possible role of vascular and lifestyle-related factors was recently proposed for age-related changes of cognitive function, predementia syndromes, and cognitive decline of degenerative (Alzheimer's disease, AD) or vascular origin (vascular dementia, VaD). At present, cumulative evidence suggests that vascular risk factors may be important in the development of mild cognitive impairment (MCI), dementia, and AD. Among vascular-related factors, metabolic syndrome (MetS) has been associated with the risk of cognitive decline, overall dementia, and VaD, but contrasting findings also existed on the possible role of MetS in AD. If MetS is associated with increased risk of developing cognitive impairment, regardless …of mechanism, then early identification and treatment of these individuals at risk might offer new avenues for disease-course modification. Strategies towards early and effective risk factor management could be of value in reducing risk of metabolic and cognitive decline. Future research is needed to confirm the association between MetS and cognitive impairment and to determine the exact mechanism linking them. Such would provide important insights into the causes and interdependencies of predementia and dementia syndromes, and inspire novel strategies for treating and preventing these disorders. At present, vascular risk factor and MetS management could be employed to delay the onset of dementia syndromes or to prevent the progression of predementia syndromes. In the future, trials could be undertaken to determine whether modifications of these risk factors, including inflammation, could lower risk of developing cognitive decline. Show more
Keywords: Alzheimer's disease, dementia, diabetes mellitus, HDL cholesterol, hypertension, hypertriglyceridemia, metabolic syndrome, mild cognitive impairment, obesity, predementia syndromes, vascular dementia, vascular risk factors
DOI: 10.3233/JAD-2010-091669
Citation: Journal of Alzheimer's Disease, vol. 21, no. 3, pp. 691-724, 2010
Authors: Pilotto, Alberto | Sancarlo, Daniele | Panza, Francesco | Paris, Francesco | D'Onofrio, Grazia | Cascavilla, Leandro | Addante, Filomena | Seripa, Davide | Solfrizzi, Vincenzo | Dallapiccola, Bruno | Franceschi, Marilisa | Ferrucci, Luigi
Article Type: Research Article
Abstract: Aim of this study was to evaluate the usefulness of a Multidimensional Prognostic Index (MPI) based on a Comprehensive Geriatric Assessment (CGA) for predicting mortality risk in older patients with dementia. The present was a retrospective study with a year of follow-up that included 262 patients aged 65 years and older with a diagnosis of dementia. A standardized CGA that included information on clinical, cognitive, functional, and nutritional aspects, as well as comorbidity, medications, and social support network, was used to calculate MPI. The predictive value of the MPI for all-cause mortality over 1 month, 6 months, and 12 months …of follow-up was evaluated. Higher MPI values were significantly associated with higher mortality at 1 month (MPI-1, low risk = 0%, MPI-2, moderate risk = 5.2%, MPI-3, severe risk = 13.7%; p < 0.002), 6-months (MPI-1 = 2.7%, MPI-2 = 11.2%, MPI-3 = 28.8%; p < 0.001), and 12-months (MPI-1 = 2.7%, MPI-2 = 18.2%, MPI-3 = 35.6%; p < 0.001) of follow-up. The discrimination of the MPI was also good, with areas under the ROC curves of 0.77 (sensitivity = 82.9%, specificity = 66.0%, with a cut off value > 0.16) at 12-months of follow up. In conclusion, the MPI, calculated from information collected in a standardized CGA, accurately stratified hospitalized elderly patients with dementia into groups at varying risk of short- and long-term mortality. Show more
Keywords: Comprehensive Geriatric Assessment (CGA), dementia, mortality, Multidimensional Prognostic Index (MPI), prognosis, survival
DOI: 10.3233/JAD-2009-1139
Citation: Journal of Alzheimer's Disease, vol. 18, no. 1, pp. 191-199, 2009
Authors: Pilotto, Alberto | D'Onofrio, Grazia | Benelli, Edoardo | Zanesco, Antonio | Cabello, Ana | Margelí, M. Carmen | Wanche-Politis, Sophia | Seferis, Kostas | Sancarlo, Daniele | Kilias, Dimitrios | on behalf of the HOPE Investigators
Article Type: Research Article
Abstract: Within the frame of the European Commission funded Smart Home for Elderly People (HOPE) Project, relatives/caregivers of 223 Alzheimer's Disease (AD) patients were recruited in Italy, Spain, and Greece for a multicenter international survey on the potential role of Information and Communication Technology system (ICT-systems) for AD patients. A five-minute video on HOPE ICT-systems was shown, and all relatives/caregivers completed a 13-item questionnaire that evaluated the potential role of: A) ICT-systems in improving quality of life, care, and safety; B) devices for monitoring personal movements, medication use, and ambient environmental conditions; C) devices to improve communication, home-based rehabilitation, and reduction …of specific risks; and D) possible agreement in using ICT-systems by AD patients. Relatives/caregivers reported that ICT-systems could be very useful to improve: A) quality of life (66.4%), care (56.1%), and safety (87.0%); B) monitoring bed rest and movements (80.7%), medication use (87.4%), and ambient environmental conditions (85.2%); and C) emergency communication (83.4%). Relatives/caregivers reported that ICT-systems could be significantly more useful for AD patients aged 75–84 than patients aged <75 or ≥85 years (p < 0.0001) and with moderate than mild or severe dementia (p < 0.0001). Relatives/caregivers aged ≥50 years and with low educational level considered ICT-systems more useful than relatives/caregivers aged <50 years (p < 0.0001) and with high educational level (p < 0.0001). In conclusion, relatives/caregivers considered that the HOPE ICT-system could be useful to improve the management of AD patients. Show more
Keywords: Alzheimer's disease, HOPE project, quality of care, quality of life, safety, user-friendly high-technology systems
DOI: 10.3233/JAD-2010-101164
Citation: Journal of Alzheimer's Disease, vol. 23, no. 1, pp. 131-141, 2011
Authors: Seripa, Davide | Matera, Maria Giovanna | Franceschi, Marilisa | Daniele, Antonio | Bizzarro, Alessandra | Rinaldi, Monica | Panza, Francesco | Fazio, Vito Michele | Gravina, Carolina | D'Onofrio, Grazia | Solfrizzi, Vincenzo | Masullo, Carlo | Pilotto, Alberto
Article Type: Research Article
Abstract: Reelin, a serine protease encoded by the RELN gene, is part of the apolipoprotein E (apoE) biochemical pathway that is involved in the pathogenesis of Alzheimer's disease (AD). Sex-related differences in the epidemiology, pathology and clinical characteristics of AD have been reported. To explore the potential contribution of RELN gene variants in the pathogenesis of AD, we investigated three polymorphisms spanning the RELN locus, i.e., a triplet tandem repeat in the 5'UTR and two single-nucleotide polymorphisms (SNPs) rs607755 and rs2229874, located in the splice-junction of exon 6 and in the coding region of exon 50. The analysis was made in …223 sporadic AD patients and 181 age-matched controls of Caucasian ethnicity. Significant differences between AD patients and controls were found in distribution of 5'UTR and rs607755 genotypes, whereas no differences were found in the distribution of rs2229874 genotypes. When patients and controls were divided according to sex, significant differences in genotype distribution were found in females and not in males, also after adjustment for APOE genotypes. These findings suggest that RELN gene variants may play a role in the pathogenesis of AD, particularly in females. Show more
Keywords: Alzheimer's disease, apolipoprotein E, case-control studies, gene polymorphism, Reelin, RELN, risk factors, single-nucleotide polymorphism
DOI: 10.3233/JAD-2008-14308
Citation: Journal of Alzheimer's Disease, vol. 14, no. 3, pp. 335-344, 2008
Authors: Seripa, Davide | Bizzarro, Alessandra | Pilotto, Andrea | Palmieri, Orazio | Panza, Francesco | D'Onofrio, Grazia | Gravina, Carolina | Archetti, Silvana | Daniele, Antonio | Borroni, Barbara | Padovani, Alessandro | Masullo, Carlo
Article Type: Research Article
Abstract: The aim of this study was to investigate the apolipoprotein E (APOE) chromosomal region in frontotemporal lobar degeneration (FTLD), and in particular in primary progressive aphasia (PPA) and the behavioral variant frontotemporal dementia (bvFTD). To this aim, we selected three single-nucleotide polymorphisms (SNPs) rs2075650 and rs157590 (TOMM40), and rs1064725 (APOC1), representative of the linkage disequilibrium (LD) blocks at the 19q13-q13.2 chromosomal region. The SNPs rs429358 and rs7412 forming the APOE polymorphism were also included in the study. The analysis was made in 282 patients with a clinical diagnosis of sporadic FTLD, namely 207 bvFTD and 75 PPA, and 296 cognitively …healthy control subjects. LD (r2 = 0.35) between TOMM40 (rs2075650) and APOC1 (rs1064725) was observed in PPA, but not in controls and in bvFTD. Inside this region of 26.9 kb, LD (r2 ≥ 0.50) between TOMM40 (rs2075650) and APOE (rs429358) was observed in bvFTD and in controls, but not in PPA. Inside this region of 16.3 kb, LD (r2 = 0.14) between TOMM40 (rs157590) and APOE (rs429358) was observed in PPA, but not in bvFTD and in controls. Although the genetics of PPA and bvFTD needs further investigation, our results suggested the presence of a different genetic background underlying PPA and bvFTD at the 19q13-q13.2 chromosomal region. Show more
Keywords: APOC1, APOE E, behavioral variant of frontotemporal dementia, frontotemporal lobar degeneration, primary progressive aphasia, TOMM40
DOI: 10.3233/JAD-2012-120403
Citation: Journal of Alzheimer's Disease, vol. 31, no. 4, pp. 731-740, 2012
Authors: D’Onofrio, Grazia | Sancarlo, Daniele | Raciti, Massimiliano | Burke, Megan | Teare, Aimee | Kovacic, Tanja | Cortis, Keith | Murphy, Kathy | Barrett, Eva | Whelan, Sally | Dolan, Aisling | Russo, Alessandro | Ricciardi, Francesco | Pegman, Geoff | Presutti, Valentina | Messervey, Thomas | Cavallo, Filippo | Giuliani, Francesco | Bleaden, Andy | Casey, Dympna | Greco, Antonio
Article Type: Research Article
Abstract: Background: In the EU funded MARIO project, specific technological tools are adopted for the people living with dementia (PLWD). In the final stage of the project, a validation of the MARIO companion robot was performed from August to October 2017. Objective: The aims of the present study are: 1) to illustrate the key results and evidence obtained in the final evaluation phase of the project across the three different pilot sites; 2) to assess the engagement dimensions of the PLWD who interacted with the MARIO robot; and 3) to assess the acceptability and efficacy of the MARIO companion robot on …clinical, cognitive, neuropsychiatric, affective and social aspects, resilience, quality of life in PLWD, and burden level of the caregivers. Methods: 38 people (M = 14; F = 24) with Alzheimer’s disease were screened for eligibility and all were included. The following tests were administered Pre and Post interactions with MARIO: Observational Measurement of Engagement (OME), Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT), Frontal Assessment Battery (FAB), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia (CSDD), Multidimensional Scale of Perceived Social Support (MSPSS), 14-item Resilience Scale (RS-14), Quality of Life in Alzheimer’s Disease (QOL-AD), Caregiver Burden Inventory (CBI), Tinetti Balance Assessment (TBA), and Comprehensive Geriatric Assessment (CGA) was carried out. Results: In Post-MARIO interactions, significant improvements were observed in RS-14 (p = 0.020).Considering the age of the people, PLWD with 68–76 years perceived that they had major social support (MSPSS Total: p = 0.016) and friends to support them (MSPSS Fri: p = 0.014). Indeed, the younger people (55–67 years) were less depressed (CSDD: p = 0.033), and more resilient (RS-14: p = 0.003). The people aged 77–85 years perceived they had major family support (MSPSS Fam: p = 0.018). The participants were gender and education matched without any statistically significant difference. Conclusion: MARIO may be a useful tool in mitigating depression and loneliness, while enhancing social connectedness, resilience, and overall quality of life for people with dementia. Show more
Keywords: Acceptability, comprehensive geriatric assessment, dementia, loneliness, resilience, robots, quality of care, quality of life, safety
DOI: 10.3233/JAD-181165
Citation: Journal of Alzheimer's Disease, vol. 68, no. 4, pp. 1587-1601, 2019
